What six health authorities say about surgical hand-washing
We compared what the WHO, France, the United States, the United Kingdom, Germany and Japan actually recommend for surgical hand hygiene. The scrub brush has disappeared everywhere; the duration hasn't — and it isn't just a matter of local habit.
A consensus that has taken hold everywhere
Skin brushing has disappeared from all recent recommendations. It abrades the epidermis and increases shedding of skin flora: alcohol-based hand rub is now the reference method, whatever the country.
A duration that varies threefold
For an identical microbiological target, Germany (RKI) validates 1.5 minutes based on the EN 12791 standard, while the historical North American scrub (CDC/AORN) calls for up to 5. France (SF2H) sits around 3 minutes, the WHO and the United Kingdom (NICE) between 2 and 5, Japan (JSIPC) between 1 and 3.
What explains the gap
No duration transfers from one product to another: what counts is the time validated for the product actually installed above the sink. The difference between countries mostly reflects different products and validation standards, not a disagreement over the effectiveness of the rub itself.
The step most often skipped
In audits, the most common gap isn't the duration: it's drying. Hands that are still damp dilute the alcohol and cancel out the effectiveness of the rub, whatever the stated contact time.
Fact sheet: surgical hand-washing around the world
1 · Comparison by country
| Authority | Reference method | Duration | Expected sequence | Brushing / nails |
|---|---|---|---|---|
| WHO Guidelines 2009 | Alcohol-based hand rub or antiseptic soap wash — both accepted | 2–5 min per label | Hands dry before any rub; hands + forearms up to the elbows | Skin brush proscribed. Short nails, no false nails or polish, no jewellery |
| France SF2H / HAS | Surgical hand rub with alcohol-based product as first-line; antiseptic washing no longer recommended | ~3 min 2 applications | Simple wash first (1st step of the session), full drying, then 2 successive rubs | Brushing limited to nails, only at the first wash of the day. Bare hands required |
| United States CDC · AORN | Two equivalent options: antiseptic soap scrub, or persistent-activity alcohol rub | 2–6 min scrub: per label | Subungual cleaning with a nail stick before the 1st case; timed method or anatomical method | False nails forbidden; nails < 6 mm. Brush not required (sponge accepted) |
| United Kingdom NICE · epic3 · AfPP | Antiseptic wash (chlorhexidine or povidone-iodine) at the 1st step, alcohol rub thereafter | 2–5 min 1st scrub the longest | Graduated approach: full procedure at the start of the list, shortened between two clean cases | Single-use nail brush only. No jewellery, sleeves rolled above the elbow |
| Germany RKI / KRINKO | Alcohol disinfection exclusively, with products tested to the EN12791 standard | 1.5 min the shortest | Hands washed well in advance (≈10 min before) so skin is dry; rub kept wet throughout | No brushing at all. Polish, false nails, rings and watches forbidden in the operating zone |
| Japan JSIPC · hospital societies | Two-stage method: short wash, then alcohol rub — transition under way from the long scrub | 1–3 min + 1 min wash | Careful drying with a sterile towel between wash and rub — a formalised step | Practices vary by facility; brush scrubbing persists in some operating rooms |
Durations are indicative; confirm against the current edition of the referenced standard and the label of the product in use.
2 · The technique, step by step
3 · Best practices
Sources: WHO, Guidelines on Hand Hygiene in Health Care · SF2H, hand hygiene recommendations · CDC, Guideline for Hand Hygiene in Healthcare Settings and AORN Guidelines for Perioperative Practice · NICE QS61 and epic3 · RKI/KRINKO, Händehygiene in Einrichtungen des Gesundheitswesens · EN12791 standard. This document is a comparative summary intended for committee discussion; it does not replace the validated institutional protocol.
Key takeaways
- One single method in the OR: alcohol-based hand rub
- Post the validated duration of the product actually in use, not a figure imported from another standard
- Remove skin brushes from stock; keep only single-use nail brushes
- Audit drying as closely as timing